How ObamaCare's Individual Mandate Could Go Down

Credit:Whitehouse.govCredit:Whitehouse.govOver at The Atlantic, Chris Frates covers Senate Minority Leader Mitch McConnell’s “secret plan to repeal ObamaCare,” which turns out to be an old plan to repeal the law’s mandate through the reconciliation process after regaining the Senate majority in the 2012 election. The plan ran into a small problem with Republicans took it in the eye at the polls. They didn’t win the presidency, and they didn’t retake the Senate either.

But the push to repeal ObamaCare’s individual mandate is not dead yet. Republicans in Congress already see it as vulnerable simply because it’s the least popular part of the law. Implementation troubles could mean that the requirement becomes even less popular by the end of the year.

ObamaCare’s health insurance exchanges are currently set to start enrolling people in October. Or at least they’re supposed to. Recent comments from federal officials, however, involved in the exchange process do exactly inspire great confidence.

“It’s only prudent to not assume everything is going to work perfectly on day one,” Gary Cohen, a Medicare official who is heading up the implementation process for the administration, recently told a group of health insurance industry insiders. Cohen’s colleague Henry Chao, who is managing the technology behind the exchange, told insurers he was “pretty nervous” about the start of enrollment. And while Cohen continued to insist that every state would have an exchange ready by October, he admitted that the federal government was making contingency plans, noting that “there is some possibility that the type of exchange may be different than what we’re looking at today.” A recent survey of health industry executives, meanwhile, found that 70 percent did not think the federal government would have the exchanges ready on schedule.

So what happens if the exchanges aren’t ready on time? Or what if the exchanges open—but there are big problems with enrollment? The exchanges, which are intended to both allow individuals to select insurance plans and determine eligibility for the law’s subsidies, are the primary vehicle for individual compliance with the mandate. Which means that if even a handful of the exchanges—remember, there’s one for every state—aren’t open or aren’t broadly functional, then large numbers of people are likely to have trouble complying with the individual mandate.

And if that happens, there will be an awful lot of pressure to repeal, or at least delay, the mandate. Indeed, it’s the kind of pressure you can plausibly imagine pushing Democrats to vote against the requirement. Remember, many Democrats were wary of the mandate. As a White House candidate in 2008, President Obama openly opposed it. If complying with the mandate is difficult enough, then it’s possible—maybe not likely, but possible—to imagine Democrats agreeing to strike the provision, or delay its implementation.

And what then? Well, Democrats have (probably correctly) pointed out that the law’s insurance industry reforms don’t really work without a mandate to ensure that most everyone buys in. But here's the thing: If the mandate gets taken down under the above scenario, it’ll be because the law isn’t working with the mandate either.

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  • Tim||

    "But here's the thing: If the mandate gets taken down under the above scenario, it’ll be because the law isn’t working with the mandate either."

    Choke me in the shallow water, before I get too deep.

  • Rich||

    “It’s only prudent to not assume everything is going to work perfectly on day one,” [said] Gary Cohen, a Medicare official who is heading up the implementation process

    "As a matter of fact, that is why I never have bought a new car," he continued, "or had sex."

  • Slammer||

    Whenever a politician says the word prudent, someone's gonna get fucked

  • Xenocles||

    As was said on Instapundit, I don't think that plan was ever a secret.

  • John Thacker||

    Delaying the mandate could become the SGR "doc fix" of Obamacare.

  • yonemoto||

    It's going to go down because it's a blatant violation of equal protection. How can you force asian people/black people to participate in health care exchanges that are tailored for the market of white people diseases? Up till now, that's fine, since the supreme court has maintained that the 14th amendment only applies to the states, but the justices in their ruling on DOMA are really rushing to reverse-incorporate the 14th amendment to the federal government.

  • Juice||

    5th amendment?

  • Tulpa (LAOL-PA)||

    Without the individual mandate, the private health insurance industry will collapse. Unless the community rating provision (ie, must accept preexististing conditions) is also repealed.

  • Xeones||

    Some paranoid part of me thinks that was the plan all along. With private insurance companies dead, what other choice will the Feds have but to institute universal health care?

  • DaveAnthony||

    I think repealing only the mandate would be a mistake. Because then all of the laws failings will be blamed on the lack of the mandate -- and not because the whole law is a pile of shit.

    It'll be just like the repeal of Glass-Steagall -- OMG YOU GUYS DEREGULATION CAUSED THE FINANCIAL CRISIS!! Liberals will snag onto it and repeat until the majority of this countries idiots believe it.

    They always have an excuse for why their grand schemes seem to fail so often.

  • Auric Demonocles||

    Hooray for alt-text!

  • lfstevens||

    Obama will just delay the mandate with an executive order. No biggie.

    The more interesting bit is that even after the exchanges are up, millions will pay the "tax" instead of getting insurance. The death spiral is inevitable.

    The question is whether this is a feature or a bug. Most of the folks who voted for ACA much preferred Medicare for All, but couldn't get it. If the private insurance system collapses in the spiral, what choice will be left? M4A!

    The fact that ACA doesn't even kick in until next year is another sign that libs are playing the long game in health care finance. Otherwise, they could have replaced "no preexisting" with permanent portability and national marketing and fixed most of the uninsured problem with a fraction of the disruption that is now coming our way.

  • steve sturm||

    I think you misread the situation. Those who the mandate is supposed to force into buying insurance don't want insurance (at least not at the price they'd have to pay). Nor are the penalties large enough to force people to buy, they're likely to just maintain the no-insurance status quo. So the lack of an exchange isn't going to create the uproar needed to effect a legislative change in the law.

  • brainy435||

    A senior editor wrote this sentence:
    "ObamaCare’s health insurance exchanges are currently set to start enrolling people in October. Or at least they’re supposed to. Recent comments from federal officials, however, involved in the exchange process do exactly inspire great confidence."

    I'm not exactly a grammar Nazi, but that's pretty bad. Definitely wouldn't say it "do exactly inspire great confidence" in the editor...

  • CTObserver||

    "Democrats have (probably correctly) pointed out that the law's insurance industry reforms don't really work without a mandate to ensure that most everyone buys in."

    But the penalty for noncompliance is small (around $2,000 per family), while the full cost of an Obamacare-compliant policy will be high (around $15,000-20,000 per family). And, as far as I've heard, there are only two ways to collect the penalty: withholding of tax refunds, and voluntary payments, with no penalty for not paying. So, it wouldn't be hard for nearly anyone to avoid the penalty (er, tax) completely, but still sign up for "insurance" once he realized he would have high costs. So it seems to me the insurance industry reforms are unworkable as written. As they've also been in Massachusetts, where many patients buy insurance and then cancel it within six months.

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